COSSH-ACLFs评分模型对HBV相关慢加急性肝衰竭患者短期预后的预测价值

田小利; 吴松林; 王波; 吴刚

doi:10.3969/j.issn.1001-5256.2020.06.014

COSSH-ACLFs评分模型对HBV相关慢加急性肝衰竭患者短期预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2020.06.014

1. 西南医科大学附属医院感染科
2. 西南医科大学附属医院重症医学科

基金项目:

西南医科大学校级青年基金(02/00030794)；

详细信息

中图分类号: R512.62;R575.3
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出版历程
- 出版日期: 2020-06-20

Value of the COSSH-ACLFs model in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

Research funding:

摘要

摘要:
目的探讨COSSH-ACLFs评分模型预测HBV相关慢加急性肝衰竭（HBV-ACLF）患者短期（90 d）预后的价值。方法纳入2014年1月-2019年10月西南医科大学附属医院、2017年1月-2018年12月内江市第一人民医院及宜宾市第二人民医院确诊的HBVACLF患者573例,收集患者的一般资料及相关实验室检查指标。根据确诊后90 d患者的生存情况分为生存组（n=339）和死亡组（n=234）。符合正态分布的计量资料2组间比较采用t检验;非正态分布计量资料2组间比较采用Wilcoxon秩和检验。计数资料2组间比较采用χ2检验,等级资料2组间比较采用Wilcoxon秩和检验。采用受试者工作特征曲线下面积（AUC）比较不同评分模型对90 d预后的预测价值。结果死亡组患者年龄（Z=-0. 304,P=0. 002）、TBil（Z=-5. 961,P <0. 001）、外周血WBC（Z=-6. 027,P <0. 001）、Cr（Z=-4. 638,P <0. 001）水平明显高于生存组,Hb（Z=-2. 012,P=0. 044）、Alb（Z=-...
- 乙型肝炎 /
- 肝功能衰竭 /
- 预后
Abstract:
Objective To investigate the value of the COSSH-ACLFs model in predicting the short-term( 90-day) prognosis of patient with hepatitis B virus-related acute-on-chronic liver failure( HBV-ACLF). Methods A total of 573 patients who were diagnosed with HBV-ACLF in The Affiliated Hospital of Southwest Medical University,The First People's Hospital of Neijiang,and The Second People's Hospital of Yibin were enrolled,and their general information and laboratory markers were collected. According to the outcome on day90 after diagnosis,the patients were divided into survival group with 339 patients and death group with 234 patients. The t-test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups,and the Wilcoxon rank sum test was used for comparison of ranked data between two groups. The area under the receiver operating characteristic curve( AUC) was used to compare the value of different models in predicting 90-day prognosis. Results Compared with the survival group,the death group had significantly higher age( Z =-0. 304,P = 0. 002),bilirubin( Z =-5. 961,P < 0. 001),peripheral white blood cell count( Z =-6. 027,P < 0. 001),and creatinine( Z =-4. 638,P < 0. 001),significantly lower hemoglobin( Z =-2. 012,P = 0. 044),albumin( Z =-4. 007,P < 0. 001),and Na( Z =-4. 558,P < 0. 001),and significantly higher incidence rates of hepatic encephalopathy( Z =-7. 859,P < 0. 001),peritonitis( Z =-2. 310,P = 0. 021),and upper gastrointestinal bleeding( χ2= 11. 697,P =0. 001). Compared with the death group,the survival group had significantly better coagulation markers,prothrombin time,international normalized ratio,and prothrombin time activity( Z =-7. 737,-7. 672,and-7. 867,all P < 0. 001). MELD,MELD-Na,CLIF-COFs,CLIF-CACLFs,and COSSH-ACLFs had an area under the ROC curve( AUC) of 0. 726,0. 587,0. 712,0. 735,and 0. 750,respectively,and the COSSH-ACLFs model had a significantly larger AUC than the other four models( Z = 7. 89,18. 83,12. 49,and 5. 05,all P < 0. 001). Conclusion The COSSH-ACLFs model has a better value than CLIF-C ACLFs,MELD,CLIF-C OFs,and MELD-Na in predicting the short-term prognosis of patients with HBV-ACLF.
- hepatitis B /
- liver failure /
- prognosis

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